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Fordyce's granule: A differential diagnosis of a sinus tract
Fordyce’s granule: A differential of a sinus tract Report
diagnosis
of a case
Narvi~~ A. Gross, D.D.S., mudDuniel B. Grces, D.D.S.,” Philadelphia, Pa. DEPARTMENT SCHOOL
OF GRADUATE OF
ESDODOSTICS,
TEJIPLE
USIVERSITY
DENTISTRY
T
he appearance of ectopic sebaceousglands in the oral cavity is not an unusual occurrence. Halperin and associates2have indicated that sebaceousglands are present in approximately 80 per cent of the population. The most common sites are the buccal mucosa at the level of the occlusal plane, the lip, and the retromolar area. Guiducci and Hyman,l quoting the work of Wait and Wassiljew, have reported the presence of ectopic sebaceousgmnds on the palate and on the gingiva over the incisor teeth, although they are extremely rare in these sites. The present artmle concerns the presence of these glands on the alveolar mucosa in the region of the premolars. When first noticed, a mistaken diagnosis of a sinus tract opposite an erdodontically involved tooth was made. CASE
REPORT
A 32syear-old Caucasian man was examined because of pain in the upper right premolar region. Clinical examination revealed a slightly raised, firm, yellowish white lesion opposite the maxillary right second premo1a.r (Fig. 1). The mucosa on the contralateral side had a normal appearance. Electric pulp tests and thermal tests were made to evaluate the status of the pulps of the teeth en the involved and uninvolved sides. The maxillary right first molar and first premolar responded within normal limits to the thermal tests and to the electric pulp tester, while the second premolar gave no response. Percussion and palpation resulted in tenderness and pain involving the maxillary second premolar. Radiographic examination revealed a slight thickening of the periodontal ligament of the second premolar
*Assistant
Clinical
Professor.
885
886
Gross and Green
Fig. 1. Lesion
as it appeared
Pig. b. Loss of lamina
Fig.
3’. Wire
on clinic21 c+cnmination.
dura with thickening
(0.01 inch)
inserted
through
of periodontal
ligament.
lesion with
no continuity
with
spex of tooth.
Volume Number
Fordyce’s gmule
38 6
Fig. 4, Endodontic
(B)
therapy
Fig. 5. Photomicrograph of oral mucosa.
887
comp!ete.
:.howing
nest of sebaceous glands
(SG)
under surface
epithelium
(Fig. 2). The lesion in the alveolar mucosa over the tooth in question appeared to be a sinus tract which was closed at the time of examination. T!rerefore, a fine stainless steel orthodontic ligature wire, 0.01 inch in dia.meter, was inserted into the opening to determine whether there was any continuity between the surface lesion and the periapical involvement. A radiograph taken vvith the jvire in place showed no association with the apex of the tooth (Fig. 3). It was decided that endodontic therapy should be initiated on the maxillary second premolar. The tooth had a buccal and a lingual canal. Both canals were instrumented and obturated \vith gutta-percha cones by the lateral condensation method (Fig. 4). The softtissue lesion persisted during and after completion of the endodontic therapy. The lesion was then excised, and the tissue was submitted for microscopic examination. The diagnosis was with small focal accumulations of chronic ectopic sebaceous glands (Fordyce’s granule), inflammatory cells (Fig. 5).
SUMMARY
AND
CONCL’LJSION
Ectopic sebaceous glands appear in the oral cavity in approximately 80 per cent of the population. The presence of these glands on the gingiva or alveo-
888
Gross and Green
OS, O.M. & O.P. Themher, 1969
lar mucosa over the anterior or posterior teeth is extremely rare. The ca.sepresented here should make one cogniza.nt of the fact that these ectopic sebaceous glands must be differentiated from a closed sinus tract in certain isolated instances. REFERENCES
1. Guiclucci, A. A:, and Hyman, A. B.: Ectopie Sebaceous Glands: A Review of the Literature Regarding Them Occurrence, Histology, and Embryonic Relationships, Dermatologica 125: 44, 1962. 2. Halperin, V., Eolas, S., Jefferis, Ii. R., Huddleston, S. O., and Robinson, H. B. G.: Occurrence of Fordyce Spots, Benign Migratory Glossitis, Median Rhomboid Glossitis, and Fissural Tongue in 2,478 Dental Patients, Oral Surg. 6: 1072-1077, 1953. 3. Shafer, W. G., Hine, M. E., and Levy, A. M.: A Textbook of Oral Pathology, ed. 2, Philadelphia, 1963, W. B. Saunders Company.
diagnosis
of a case
Narvi~~ A. Gross, D.D.S., mudDuniel B. Grces, D.D.S.,” Philadelphia, Pa. DEPARTMENT SCHOOL
OF GRADUATE OF
ESDODOSTICS,
TEJIPLE
USIVERSITY
DENTISTRY
T
he appearance of ectopic sebaceousglands in the oral cavity is not an unusual occurrence. Halperin and associates2have indicated that sebaceousglands are present in approximately 80 per cent of the population. The most common sites are the buccal mucosa at the level of the occlusal plane, the lip, and the retromolar area. Guiducci and Hyman,l quoting the work of Wait and Wassiljew, have reported the presence of ectopic sebaceousgmnds on the palate and on the gingiva over the incisor teeth, although they are extremely rare in these sites. The present artmle concerns the presence of these glands on the alveolar mucosa in the region of the premolars. When first noticed, a mistaken diagnosis of a sinus tract opposite an erdodontically involved tooth was made. CASE
REPORT
A 32syear-old Caucasian man was examined because of pain in the upper right premolar region. Clinical examination revealed a slightly raised, firm, yellowish white lesion opposite the maxillary right second premo1a.r (Fig. 1). The mucosa on the contralateral side had a normal appearance. Electric pulp tests and thermal tests were made to evaluate the status of the pulps of the teeth en the involved and uninvolved sides. The maxillary right first molar and first premolar responded within normal limits to the thermal tests and to the electric pulp tester, while the second premolar gave no response. Percussion and palpation resulted in tenderness and pain involving the maxillary second premolar. Radiographic examination revealed a slight thickening of the periodontal ligament of the second premolar
*Assistant
Clinical
Professor.
885
886
Gross and Green
Fig. 1. Lesion
as it appeared
Pig. b. Loss of lamina
Fig.
3’. Wire
on clinic21 c+cnmination.
dura with thickening
(0.01 inch)
inserted
through
of periodontal
ligament.
lesion with
no continuity
with
spex of tooth.
Volume Number
Fordyce’s gmule
38 6
Fig. 4, Endodontic
(B)
therapy
Fig. 5. Photomicrograph of oral mucosa.
887
comp!ete.
:.howing
nest of sebaceous glands
(SG)
under surface
epithelium
(Fig. 2). The lesion in the alveolar mucosa over the tooth in question appeared to be a sinus tract which was closed at the time of examination. T!rerefore, a fine stainless steel orthodontic ligature wire, 0.01 inch in dia.meter, was inserted into the opening to determine whether there was any continuity between the surface lesion and the periapical involvement. A radiograph taken vvith the jvire in place showed no association with the apex of the tooth (Fig. 3). It was decided that endodontic therapy should be initiated on the maxillary second premolar. The tooth had a buccal and a lingual canal. Both canals were instrumented and obturated \vith gutta-percha cones by the lateral condensation method (Fig. 4). The softtissue lesion persisted during and after completion of the endodontic therapy. The lesion was then excised, and the tissue was submitted for microscopic examination. The diagnosis was with small focal accumulations of chronic ectopic sebaceous glands (Fordyce’s granule), inflammatory cells (Fig. 5).
SUMMARY
AND
CONCL’LJSION
Ectopic sebaceous glands appear in the oral cavity in approximately 80 per cent of the population. The presence of these glands on the gingiva or alveo-
888
Gross and Green
OS, O.M. & O.P. Themher, 1969
lar mucosa over the anterior or posterior teeth is extremely rare. The ca.sepresented here should make one cogniza.nt of the fact that these ectopic sebaceous glands must be differentiated from a closed sinus tract in certain isolated instances. REFERENCES
1. Guiclucci, A. A:, and Hyman, A. B.: Ectopie Sebaceous Glands: A Review of the Literature Regarding Them Occurrence, Histology, and Embryonic Relationships, Dermatologica 125: 44, 1962. 2. Halperin, V., Eolas, S., Jefferis, Ii. R., Huddleston, S. O., and Robinson, H. B. G.: Occurrence of Fordyce Spots, Benign Migratory Glossitis, Median Rhomboid Glossitis, and Fissural Tongue in 2,478 Dental Patients, Oral Surg. 6: 1072-1077, 1953. 3. Shafer, W. G., Hine, M. E., and Levy, A. M.: A Textbook of Oral Pathology, ed. 2, Philadelphia, 1963, W. B. Saunders Company.